HIV-infected urban youth are under significant and unavoidable stress due to living with HIV and circumstances of inner-city life. How these youth appraise and cope with stress can ameliorate its negative effects on their lives. Mindfulness-based stress reduction (MBSR) is a structured 8-week program of instruction in mindfulness meditation that has been shown to improve psychological and quality of life outcomes in adults with chronic diseases. Our pilot study of MBSR for HIV-infected and at-risk urban youth showed beneficial effects in psychological and interpersonal functioning, highlighting the promise of this intervention. A Phase II randomized controlled trial (RCT) of MBSR is the next step in evaluating whether MBSR is an effective means of reducing stress and improving health outcomes in this vulnerable population. The proposed research will address 2 specific aims: 1) to estimate the effect size of MBSR on psychological and interpersonal functioning among HIV-infected youth and 2) to determine if positive effects of MBSR on psychological and interpersonal functioning in HIV-infected youth are mediated by changes in appraisal and coping processes. To accomplish these aims, we will conduct a small RCT with HIV-infected urban youth, aged 15-20 years, of the MBSR vs. an attention control program. Assessments of psychological and interpersonal functioning will occur at baseline, program completion, and 3 month follow-up and include: mindfulness;perceived stress, threat appraisal, and coping;psychological functioning (depression, anxiety, hostility, and mood states);and interpersonal functioning (aggression and interpersonal skills). We expect MBSR to result in improved outcomes. The results of this pilot RCT will be used to develop a larger, multi-site RCT and R01 application to be submitted in year 3 of this application. Given the far-reaching effects of chronic stress on morbidity and mortality, identification of MBSR as a successful stress-reduction intervention for HIV-infected youth has widespread public health significance. Additionally, much MBSR research remains atheoretical and little work has examined potential mechanisms of action. With the burgeoning interest in mindfulness, research must explore its potential therapeutic mechanisms. This R21 proposal, grounded in theory on stress, coping, and neuropsychology, will be an important step in this direction. PUBLIC HEALTH RELEVANCE: Mindfulness-based stress reduction (MBSR) may be beneficial for HIV-infected youth. We will evaluate the MBSR program compared with an attention control among HIV- infected youth to estimate its effect and how it may be helpful.